Diastology

For a more comprehensive understanding of diastolic function, readers are encouraged to consult the joint recommendations of the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) for the echocardiographic assessment of left ventricular diastolic function (doi:10.1016/j.echo.2016.01.011). Since these guidelines do not focus on the fundamentals of image acquisition and measurements, I recommend reading this chapter first.

For beginners, I recommend starting with the following three straightforward measurements:

1. Mitral inflow velocities measured with pulsed-wave (PW) Doppler (E- and A-waves)
2. Tissue Doppler imaging (TDI) measurement of the lateral mitral annulus (e′ wave)
3. Assessment of left ventricular wall thickness

These findings can then be complemented, when necessary, by measurements of left atrial size and pulmonary artery systolic pressure.

In clinical practice, echocardiographic assessment of diastolic function aims to estimate whether the patient’s left ventricular filling pressure is normal or elevated. The true filling pressure can only be measured invasively with cardiac catheterization.